US 7909843 B2
A surgical port and dilator are useful for creating access to surgical sites having tortuous geometries and/or requiring relatively long and narrow access to the surgical site. The surgical port or dilator can be provided with an oblique distal end to facilitate placement and the displace tissue near angled surfaces. The surgical port can be inserted into the operative site following dilation in the same fashion as a conventional port. Once inserted, however, the surgical port may then be elongated to provide relatively long and narrow, elliptically- shaped access to the surgical site. The elongation of the port allows the surgeon access to long and narrow surgical sites, such as the spine, without having to expand radially. This reduces trauma to the patient. A locking means is also provided to hold the surgical port in the open position until a release mechanism is activated.
1. An extendable surgical port comprising:
a first body segment having a proximal end and a distal end opposite the proximal end;
a second body segment having a proximal end and a distal end opposite the proximal end;
a first frame section attached to the proximal end of the first body segment;
a second frame section attached to the proximal end of the second body segment;
a first frame arm attached to the first frame section and the second frame section such that the second frame section is slidable along the first frame arm relative to the first frame section between a closed position and an extended position;
a locking bar engageable with the second frame section and the first frame arm to secure the second frame section relative the first frame arm by directly contacting the locking bar with at least one contact point on the first frame arm, wherein the contact point is not a notched surface, wherein the locking bar includes a hole configured to receive the first frame arm, and wherein the locking bar is configured to extend from a pivot point on the second frame section; and
a spring disposed between the locking bar and the second frame section, the spring configured to bias the locking bar about the pivot point, wherein the spring is recessed into the second frame section, wherein the locking bar is configured such that pivoting the locking bar about the pivot point toward the second frame section compresses the spring toward the second frame section and releases contact between the locking bar and the first frame arm, thereby unsecuring the second frame section such that the second frame section is slidable along the first frame arm.
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The disclosed inventions relate to surgical ports and associated dilators. In particular, the inventions relate to surgical ports and dilators useful for minimally invasive surgery.
In the past, surgery typically required large incisions to provide visual and instrument access to the surgical site. These large incisions resulted in significant blood loss, damage to muscle tissue, long healing times accompanied by prolonged pain, and significant scarring. Today, however, many surgeries are conducted using minimally invasive techniques. These techniques minimize patient trauma by creating a relatively small incision, followed by the introduction of dilators to increase the effective size of the incision. Following dilation, surgery is performed through a surgical port inserted into the dilated incision. Instead of cutting through the muscle surrounding the surgical site, dilation effectively splits the muscle. Splitting, rather than cutting the muscle causes less damage to the muscle and leads to faster recovery times and reduced patient discomfort.
Dilators develop a channel from the subcutaneous layer of a patient to the site of operation. A small incision, paralleling any underlying muscle, is made slightly longer than ½ the circumference of the largest dilator, or if used, port. A solid, pointed rod, variously described as a first dilator or guidewire, is then inserted into the incision to penetrate the underlying structures and reach the surgical site. It is best if the rod can be positioned against a bony surface as application of the dilators will attempt to push this rod forward. X-rays may be taken before and/or after insertion of the rod to confirm placement at the desired surgical site.
Increasingly larger diameter dilators can then be sequentially placed over each other to enlarge the channel. The larger diameter of the sequential dilators help to dilate the path of exposure while the series of tubes lessens the forces needed to create the path. The pointed tip of the dilators eases insertion and helps to widen the base of the channel when the dilator is orbited around a central axis formed through the center of the dilator along its length at the level of the skin.
In lieu of dilation, mechanical retractors can be used. Mechanical surgical retractors are hand-held or table-mounted metal retractor blades that are inserted into the incision, and thereafter retracted and held or locked in place to increase the effective opening of the incision. A drawback of using retractors is that, in comparison to dilators, a relatively large incision must be made to provide for placement of the retractor blades. Dilators and surgical ports, on the other hand, typically gain access to the surgical site by making a smaller incision, inserting a small probe into the incision, and then creating a progressively larger circular opening by repeatedly sliding larger dilators over the probe, thereby splitting the muscle. This splitting of the muscle is less traumatic and therefore offers a quicker post surgery recovery.
Conventional dilators and surgical ports, however, are not suitable for all surgical applications. For example, conventional dilators are unable to completely dilate muscle away from the lamina of the spine due to the tortuous geometry of the lamina. Thus, muscle located between the dilator and the lamina must typically be cut away to access the lamina when using conventional dilators.
Due to the geometry of the spine, many spinal surgical procedures require a long, narrow opening. Thus, another drawback of dilators is that a circular opening is not practical for most spinal surgeries because of the limited access it offers to the spine given the size of the dilated opening. The use of dilators and surgical ports are therefore generally limited to procedures involving very precise access to the spine, such as for single level discectomy.
Mechanical retractors, on the other hand, offer the promise of a long, narrow opening. As discussed above, however, mechanical retractors require a relatively large initial incision that involves cutting, rather than splitting of muscle.
Hence, there is a long-felt need for a device and method for enlarging minimally invasive incision by dilation, regardless of the orientation of the surgical access in relation to the surgical site. There is also a long-felt need for a device and method for enlarging minimally invasive incision by dilation that can displace muscle away from surgical sites possessing a tortuous geometry. Furthermore, there is also a long-felt need for a device and method for enlarging the dilated incision to create a long and narrow access to the surgical site by splitting, rather than cutting muscle surrounding the surgical site.
A novel surgical port and dilator is provided for surgeons requiring a minimally invasive access to a surgical site. The present surgical port and dilator are particularly advantageous because the surgical port and/or the dilator can be configured with an oblique distal end. This oblique distal end is advantageous in surgeries where the surgical site is not level to the plane of the patient, e.g. spinal surgeries. Furthermore, various configurations of the oblique distal end of the surgical port and/or dilator facilitates the displacement of muscle from areas having tortuous geometries, such as the spinal lamina. In addition, the present surgical port can create a relatively long and narrow access to the surgical site by splitting the muscle surrounding the surgical site, rather than cutting it. The distal end of the surgical port can also be angled to accommodate the position of the surgical site in relation to the plane of the surgical access to the patient.
The present surgical dilators are inserted into a minimally invasive incision in the same fashion as a conventional dilator. Once inserted, however, the oblique distal end of the dilator can conform to a surgical site that is not aligned with the plane of the patient. Moreover, the dilator can be manipulated to maneuver along angled surfaces. In this case, the outer dilator can be replaced by one that is tapered on one or both sides. The tip of this taper can be placed against the highest portion of the base and then rotated, while keeping contact with bone, to the lowest point. In the spine, the tip begins at the base of the spinous process, rotates along the lamina, and comes to rest near the facet joint.
The outer dilator diameter is just under the inner diameter of the surgical port, and a surgical port with an oblique distal end can therefore be placed over the dilator, and the same motion repeated. This further clears muscle off of the bony base and helps move it to the periphery of the surgical port. With downward pressure on the surgical port, the dilators can be removed and the holding fixture can be applied.
The surgical port can also enlarge access to the surgical site, either in conjunction with dilators or by itself. The access created by the dilators is substantially circular, while the access created by the surgical port is relatively long and narrow. The elongation of the port allows the surgeon access surgical sites, such as the spine, where an expansion in diameter is not needed and may result in unnecessary trauma to the patient. A locking means is also provided to hold the surgical port in the open position until a release mechanism is activated.
A full and enabling disclosure of the present invention, including the best mode thereof, directed to one of ordinary skill in the art, is set forth in the specification, which makes reference to the appended figures, in which:
Repeat use of reference characters throughout the present specification and appended drawings is intended to represent same or analogous features or elements of the invention.
Reference now will be made in detail to the embodiments of the invention, one or more examples of which are set forth below. Each example is provided by way of explanation of the invention, not limitation of the invention. In fact, it will be apparent to those skilled in the art that various modifications and variations can be made in the present invention without departing from the scope or spirit of the invention. For instance, features illustrated or described as part of one embodiment, can be used on or with another embodiment to yield a still further embodiment. Thus, it is intended that the present invention cover such modifications and variations. Other objects, features and aspects of the present invention are disclosed in or are apparent from the following detailed description. It is to be understood by one of ordinary skill in the art that the present discussion is a description of exemplary embodiments only, and is not intended as limiting the broader aspects of the present invention.
To achieve increased access to the spinal area 58 for surgery, surgical port 50 can be elongated as shown in
Insertion of surgical port 50 in the closed position permits the surgeon to use a relatively small incision, and perhaps minimal dilation, thereby avoiding the large-scale cutting of muscle associated with increased access to spinal 58 provided by larger incisions. The desired increased access to spinal area 58 is instead created by elongating surgical port 50, thereby splitting and stretching the muscle, which minimizes cutting of the muscle.
Elongation of surgical port 50 is generally accomplished by sliding second body segment 12 away from first body segment 10 along frame arm 30. The resulting access to spinal area 58 is generally elliptical in shape due to the linear separation of generally semicircular body segments 10 and 12 (see
Following surgery on the surgical site 58, surgical port 50 can be closed, disconnected from immobilizer arm 60, and removed from the incision. The body will then close around and over the surgical site, and patient recovery times and pain levels during healing will be decreased.
Referring now to
It should be understood that while frame sections 16 and 18 and body segments 10 and 12 are depicted as separate pieces, an extendable surgical port having a unitary frame with frame sections and a unitary body with body segments is also contemplated. For example, frame sections 16 and 18 and body segments 10 and 12 could be joined by a flexible material (not shown) without departing from the scope of the extendable surgical port. Likewise, it should also be understood that although
Since the anatomy of the spine is rarely level to the plane of the patient, it is often desirable to provide distal end 14 of surgical port body 52 with an oblique, or angled surface.
To illustrate this problem,
Following dilation, an oblique surgical port 55 (depicted in
Although preferred embodiments of the invention have been described using specific terms, devices, and methods, such description is for illustrative purposes only. The words used are words of description rather than of limitation. It is to be understood that changes and variations may be made by those of ordinary skill in the art without departing from the spirit or the scope of the present surgical port, which is set forth in the following claims. In addition, it should be understood that aspects of the various embodiments may be interchanged both in whole or in part. Therefore, the spirit and scope of the appended claims should not be limited to the description of the preferred versions contained therein.
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